oral surgery and orthodontics Flashcards
soft tissue pathology
frenums
impacted canines
impacted premolar exposures
soft tissue pathology - frenums
frenectomy
frenoplasty - nowadays usually modify rather than remove
- V to Y
- Z-plasty
soft tissue pathology - impacted canines
usually buccally placed canines if no bone covering
buccal apically repositioned flap
palatal open exposure
soft tissue pathology - impacted premolar exposures
often L just ST
hard tissue pathology
impacted canines impacted premolars other extractions submerged retained deciduous teeth implants mini-implants orthognathic surgery
hard tissue pathology - impacted canines
buccal apically repositioned flap with bone removal
palatal open exposure with bone removal
buccal or palatal closed exposure with gold chain attachment
extraction
hard tissue pathology - impacted premolars
extraction
exposure with bone removal
often if early loss of Es - usually lingual or in line of arch
most common procedure
impacted canines
tx options for impacted canines
leave and monitor - relieve crowding and may spontaneously erupt (buccally) extract canine surgical exposure and ortho alignment - open or closed exposure (gold chain) - mini implants - corticotomy transplant
potential consequences of leaving and monitoring impacted canines
root resorption
dentigerous cyst
interfere with implant placement
indications for extracting impacted canine
if v high/bad position
if can achieve adequate aesthetics e.g. camouflaging 4 as a 3
minimal surgical exposure of impacted canine in line of arch
extract c
remove overlying mucosa and follicle - don’t need to raise flap, just excise ST
remove any overlying bone with Rougeurs
place Whitehead’s varnish gauze pack
- to stop ST just growing back
horizontal mattress suture
- avoid knot on palatal as can annoy tongue
can then bond erupting canine onto ortho appliance - could place bracket on when remove pack if concerned ST will grow over
where do buccally placed canines tend to erupt?
in unattached mucosa
where do palatally placed canines tend to erupt?
in attached mucosa
why is it a problem that buccally placed canines tend to erupt in unattached mucosa?
if you just incise and pull tooth down it will bring unattached mucosa down - can cause aesthetic problems
buccally placed canines pros and cons
good access
aesthetic result may not be as good as palatal
which type of mucosa do you not want to cut away?
attached mucosa
apically repositioned flap
preserve attached mucosa
x2 nearly parallel relieving incisions and a crestal incision - 3 sided flap
fold flap on itself
suture at neck of canine
can leave uncovered or place coe pack/whitehead varnish - granulates quickly, will be sore for a few days
canine will pull attached mucosa back down as it comes down
indications for canine transplant
cannot reasonably get a result by exposure and traction
potential for damage to other teeth
space is available or can be made available without premolar ext
older pt who is seeking a quick fix
canine transplant procedure
exposure of surgical site
remove canine - place in sulcus/physiologic saline to preserve PDL
prepare bone - drill to fit canine in socket fully
place canine in anatomical position - but no bone palatally as where canine used to be
close flap with sutures
Ti trauma splint (prev CoCr cap splint)
- semi-rigid - want to give PDL cells some physiologic loading
- usually 1 tooth either side - more teeth makes it too rigid
- 1-2 wks
then pulp extirpation and RCT
risk to warn pt re canine transplant
risk of ankylosis
but can still last a long time e.g. 30 years
luxation
prev used to luxe canine to encourage it to erupt
not done now as encourages ankylosis
kissing canines
one canine across line of arch, touching other canine
dilacerated canines
can be difficult to ortho realign due to hook on root
may need ext
submerged deciduous teeth
ankylosed - adjacent teeth have grown around it
often needs sectioning to remove
- can damage permanent successor
fraenectomies
frenum has opportunistically grown into space - now don’t believe it is the cause of a diastema
may remove post-tx for aesthetics/cleansing/scarring may help stability and prevent relapse
cut it out
suture resultant defect
would need pack between incisor teeth as cant suture here
V to Y frenoplasty
incise frenum V and cut out middle
stitch the centres and pull - get a Y shape
do a less aggressive technique nowadays
Z-plasty
no longer done
scarring from surgery - contraction - get reduction in size of frenum even though no removal of tissue
make a Z cut and flip two flaps round then suture
implants for ortho tx
planned moment of tooth/group of teeth causes reciprocal movement of the teeth used for anchorage during tx
implant osseointegrated
SS mini-implants
how do implants provide qualities of an ideal ortho anchor
pt compliance unnecessary absolute anchorage as no PDL easily used under variety of tx modalities easily placed removable if necessary
SS mini-implants
don’t osseointegrate but screw in with friction
self-tapping screw - don’t need drill
eventually exfoliate after 1-2 years
no healing - just remove and leaves tiny defect
be careful that you don’t place them into a root
palatal mini-implant
be careful you don’t end up in floor of nose
can take a lot of loading
corticotomy
can facilitate tooth movement - weaken buccal and palatal bone
drill gutters and into bone
teeth will move more quickly and roots don’t resorb
can be a good last resort but rare
